Abstract
BackgroundThe conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion. Despite some reports having demonstrated satisfactory outcomes of dynamic stabilization in the management of low-grade spondylolisthesis, the extensive soft tissue dissection involved during pedicle screw insertion substantially compromises the designed rationale of motion (muscular) preservation. The authors report on a novel method for minimally invasive insertion of dynamic screws and a mini case series.MethodsThe authors describe innovations for inserting dynamic screws via the cortical bone trajectory (CBT) under spinal navigation. All the detailed surgical procedures and clinical data are demonstrated.ResultsA total of four (2 females) patients (mean age 64.75 years) with spinal stenosis at L4–5 were included. By a combination of microscopic decompression and image-guided CBT screw insertion, laminectomy and dynamic screw stabilization were achieved via one small skin incision (less than 3 cm). These patients’ back and leg pain improved significantly after the surgery.ConclusionThis innovative dynamic screw stabilization via the CBT involved no discectomy (or removal of sequestrated fragment only), no interbody fusion, and little muscle dissection (not even of the Wiltse plane). As a minimally invasive surgery, CBT appeared to be a viable alternative to the conventional pedicle-screw-based dynamic stabilization approach.
Highlights
The conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion
Various fusion techniques have been accepted as the surgical management for disc degenerative disease or spondylolisthesis, including anterior, posterior, transforaminal, and extreme lateral lumbar interbody fusion (ALIF, Posterior lumbar interbody fusion (PLIF), Transforaminal lumbar interbody fusion (TLIF) and Lateral lumbar interbody fusion (LLIF)) [1,2,3,4]
The screws were placed along the cortical bone trajectory (CBT) and assembled with dynamic cords
Summary
The conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion. Pedicle-screw based dynamic stabilization systems use elastic materials, for example, a synthetic cord-and-spacer or metallic spring, instead of a rigid metallic rod, to connect between individual pedicle screws [8]. Placement of these pedicle screws requires either a midline open approach or dissection of the Wiltse plane bilaterally. The theoretical benefit of reducing ASD requires longer-term follow up to confirm, this technique spared arthrodesis and was done with minimal soft tissue or facet destruction This is the first report to describe dynamic screw placement via the CBT
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